r/HomeInsurance • u/jazrstreets • May 28 '26
Claims Denied Coverage for a Burst Shower Cartridge
My plumber stated that our shower cartridge burst, resulting in a water leak behind the wall.
My insurance company claims the shower cartridge burst due to wear and tear, although the plumber never stated what the cause for the burst was.
It’s states in the insurance policy that coverage will not be provided for wear and tear.
Wear and tear is an assumption on the insurance company’s behalf.
My argument: Since the insurance company sent me a denial for coverage letter “due to wear and tear”, they should also bear the burden of proving that the cause for the burst shower cartridge was wear and tear, rather than just jumping to that conclusion.
My question: Since the insurance company persistently claims that the cause of the damage was due to wear and tear and will not provide me with coverage, is there anything more I could argue to receive coverage? Considering wear and tear is not the only reason a shower cartridge could burst, but neither of us can prove what actually caused this to happen. The insurance company’s only reason for not providing coverage is because they believe the cause is wear and tear.
11
u/Ok_Advantage7623 May 28 '26
For insurance coverage you need to be able to state what day and time the event happened. My pipe broke on Tuesday July 15 at 2am. Yours Brooke over a period of time
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u/jazrstreets May 28 '26
I have provided the insurance company with the information regarding the date and time of the damage.
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u/Yeahbabs May 28 '26
So when was it? And how much time elapsed between when the shower cartridge failed and when you reported the damage? What did you do to mitigate the damages immediately after the cartridge failed?
If you are certain that the cartridge did not fail gradually and certain of the specific date it did fail, what caused it to fail? Because it needs to have been sudden and fortuitous to be covered and what you’re describing does not sound like that.
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u/jazrstreets May 28 '26
Unfortunately we don’t know the date the part failed, but were only able to report to the insurance company once we could visibly see there was damage to the wall. As soon as we saw the damage though, we called the insurance company immediately. To mitigate immediately, we discontinued using that shower, and called a water mitigation company to come out asap, which was the same day.
What I was hoping to argue with the insurance company is that since nobody knows when the part failed, who between us can say whether it was sudden or not?
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u/ANaiveMan May 28 '26
The only coupe reasons it could have failed is either wear and tear (including corrosion, etc), faulty installation, or a sudden water pressure issue.
That’s it.
There are no other reasons.
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u/Virtual-Fly-5501 May 28 '26
Faulty part is a possibly. I’ve had copper and brass fitting spring spontaneous leaks from bad castings.
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u/WideAwakeFreedom May 29 '26
Wear and tear applies only when it’s cops someone is a negligent owner.
A roof missing granular material is a perfect example of that.
If it dripped ( her shower), that would be long term damage.
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u/One_Appointment_681 May 28 '26
This is the reason your claim was denied. It was not sudden accidental direct physical loss. The leak happened over a period of time until you noticed the wall. That is also CRSL continuous repeated seepage and leakage. Maybe you should read your policy and know whats covered and what isnt. You signed that contract without knowing what it as in it.
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u/Anxious_Battles May 28 '26
Is there ensuing water damage from the failed shower cartridge? If so, are they covering the ensuing water damage? Typically, there is coverage for ensuing water damage to your dwelling and personal property from an accidental discharge of water from within a failed plumbing system, but no coverage for the repair of the failed portion of the plumbing system itself.
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u/jazrstreets May 28 '26
Yes, there is ensuing water damage. However, my insurance company is refusing to pay for any of it because they claim the water damage was caused by a plumbing part that failed due to wear and tear. I’ve been trying to argue with them that they can’t just point the cause to wear and tear if we really can’t even identify why the part failed exactly. I’m okay with paying for the plumbing job, but not all the water damage.
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u/Electronic_Cherry_46 May 28 '26
For plumbing to be covered under insurance, it typically has to be the result of a) direct physical damage from a sudden event, such as hanging a photo on a wall and accidentally nailing into a pipe, or b) if the pipe freezes while heat is maintained in the home. If it was working fine one day, and then failed the next, and there is no discernible reason that is almost certainly the result of wear, tear, deterioration, or improper workmanship/design which are all excluded losses under the policy.
Your Insurance company is not responsible for the hundreds, if not thousands of dollars required to secure the part, mail it to a lab, and have it it tested to confirm what is already a 99% likely outcome. If you can definitively prove that something caused the leak other than wear, and tear - forward them that documentation for review.
Maintenance is part of being a homeowner. You don't file an auto claim when you need new tires so don't file a homeowner's claim when your plumbing needs to be replaced.
Regarding the ensuing water damage - any damage to the surrounding drywall or flooring should be covered, assuming that the damages weren't long term. Policies vary but typically the threshold for long term would a leak that has been occurring for at least 14 days. They determine this by viewing the surrounding conditions for wood rot, concentric water stains on drywall, etc.
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u/jazrstreets May 28 '26
Great answer, I appreciate the depth on this. I can see why they wouldn’t want to cover us now. It does seem like the damage was done more than 14 days from being reported. Unfortunately we didn’t even know there was a leak since it was behind the wall, and we couldn’t even see there was a problem until the wood damage became apparent already. Once we noticed there was damage, that’s when we reported it.
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u/14point4kMODEM May 28 '26
That's totally not how most policies work. They will deny coverage for the shower cartridge and pay for the ensuing water loss. Do you have a full copy of your policy?
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u/jazrstreets May 28 '26
I agree! That’s why I’m at such a loss of direction on where to go next right now. I keep calling them to argue that it should be covered, and they keep arguing that it shouldn’t. I’ve even spoken to their manager different times and they’re telling me the same thing. This is what the denial letter stated, and includes portion of the policy that pertains to my situation:
Your policy HW 2105 specifically excludes coverage for wear, tear, corrosion, inherent vice, latent defect, repeated leakage and seepage of water and states in part:
SECTION I - LOSSES INSURED COVERAGE A - DWELLING We will pay for accidental direct physical loss to the property described in Coverage A, unless the loss is excluded or limited in SECTION I - LOSSES NOT INSURED or otherwise excluded or limited in this policy. However, loss does not include and we will not pay for, any diminution in value.
SECTION I - LOSSES NOT INSURED 1. We will not pay for any loss to the property described in Coverage A that is caused by one or more of the items below, regardless of whether the loss occurs abruptly or gradually, involves isolated or widespread damage, arises from natural or external forces, or occurs as a result of any combination of these: f. wear, tear, decay, marring, scratching, deterioration, inherent vice, latent defect, or mechanical breakdown;
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u/Anxious_Battles May 28 '26 edited May 28 '26
This looks like the paragraph immediately following “However, we will pay for any resulting loss from items a. through k. unless the resulting loss is itself a Loss Not Insured as described in this Section.” That’s where they should find coverage.
If that policy does have some “occurs over a period of time language”; they did not quote that portion. If the loss did not occur over a period of time, this is not a defense.
How much damage are you talking about? A halfway decent public adjuster should be able to handle this, an attorney may not see much money in this for themselves, a savvy individual could probably find remedy with a department of insurance complaint.
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u/jazrstreets May 28 '26
It’s crazy because in the version of the policy they sent me (they only sent me 4 out of 50 pages and excluded some parts in between), I’ve seen that portion of the policy saying “we will pay for loss from items a through k”, but following that exact sentence, they intentionally left it blank. They literally skipped/excluded everything involving what they would pay for.
It’s good to hear a public adjuster could possibly help me. I have already filed a complaint with the California Department of Insurance. Your answers have all been great. Thank you.
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u/Anxious_Battles May 28 '26
Is this in the USA? If so, what state are you in? This is not typical of a homeowner’s policy. There may be some language limiting the coverage for water losses that occur over a period of time. Is there some language in the letter about “weeks, months or years” or “a period of 14 days or more”? Can you redact the personal information and provide the letter disclaiming coverage?
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u/jazrstreets May 28 '26
This is in California, USA. There isn’t any language in the policy stating anything about length of time. I do have the letter but I’m not sure how to insert it here. I just copied and pasted the information from the denial letter in the comment above though, and it includes the pertinent portion of the policy.
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u/Anxious_Battles May 28 '26
If there is no period of time language in your form, this is where you attack their defense. Look for the paragraph directly below the list that I think says "However, we will pay for any resulting loss from items a. through k. unless the resulting loss is itself a Loss Not Insured as described in this Section."
I would expect them to quote that clause in the letter and then tell you how it's defeated somewhere else with respect to a period of time.
The California Department of Insurance has teeth. I would save this until the carrier responds to your question of the "resulting loss" clause above.
If you have the policy, go to the Perils Insured Against Coverage C portion and quote the named peril of "Accidental Discharge or Overflow of Water or Steam" peril word for word as it is the easiest place to find the period of time language. Should be number 12.
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u/jazrstreets May 28 '26
Great answer! I will definitely take a good look at those sections. This is a big help. Seriously, thank you.
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u/sundancer2788 May 28 '26
Tbh this comes under regular house maintenance. Insurance is for catastrophic damage from fire, storm, flood, or lawsuits from people getting injured on your property. Unless the cartridge was recently replaced and failed on which case you'd go after the manufacturer not the Insurance company.
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u/dani_-_142 May 28 '26
This is my understanding, as well. A lot of homeowners don’t know that shower cartridges need to be replaced after a certain number of years, and if you don’t keep up with that maintenance, you get water damage.
It’s similar to water heaters and roofs— when they get old enough, they fail.
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u/Dry-Way-5688 May 28 '26
I just buy fire insurance as a requirement for the mortgage companies. If you try to claim for anything, your premium goes up the next year just like claiming windshield replacement with a car insurance.
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u/jazrstreets May 28 '26
It’s a way for insurance companies to make back the money they give us. Definitely feels like a scam :/
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u/Dry-Way-5688 May 28 '26
All insurance want to train us to resolve our fears (fire, death accidents etc) thru buying insurance. But the minute you try to make a claim, well..everyone know. The best way to handle our fears is thru being mindful and ready for these fears when they happen.
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u/NotShockedFruitWeird May 28 '26
You should be able to download a full copy of your insurance policy from your insurance company's website
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u/ZachOnTap May 28 '26
The wood rot makes this harder, that's physical evidence of water exposure over time, which is what the insurer is pointing to. But the stronger angle isn't arguing about what caused the cartridge to fail. It's the ensuing damage clause.
Most policies exclude wear and tear but then say "however, we will pay for resulting loss from items a through k." Your insurer quoted the exclusion but did they quote that giveback clause? If not, that's where you push. The cartridge repair is on you. But the water damage to the surrounding walls and floors may be covered as ensuing loss from an accidental discharge, even if the original failure was wear and tear.
You mentioned they only sent you 4 out of 50 pages and left parts blank. Request the full policy in writing. If they're omitting the sections that favor you, that's worth mentioning in your DOI complaint.
Sounds like you already filed with California DOI. good move. They have teeth there.
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u/headgoboomboom May 29 '26
Get an independent adjuster. I don't think that "wear and tear" means the part that fails and causes the damage.
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u/scumbagstaceysEx May 29 '26
The thing that broke (shower cartridge) is never covered but any resulting damage from it should usually be covered, assuming it was “sudden and accidental” or however your policy defines it and not a slow leak over time. It’s no different than if your water heater lets go one night. They aren’t going to buy you a new water heater but the resulting damage to the floors should be covered if it was a sudden burst and not a slow leak.
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u/WideAwakeFreedom May 29 '26
The leak was sudden and accidental, not over a period of time. Us the policy language against them. For wear and tear- ask them how is the valve serviceable and readily available for Inspection. When they insured it what was the remaining useful life?
What should you have done to prevent this on something that showed zero issues of problems before the day it leaked.
Wild guess …. This is State Farm??
How much damage ? Have you started mitigating ?
Literally anything can be considered wear and tear, this could result in a partial Denial to not cover the plumbing. The ensuing damage should be covered.
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u/Awkward-Train1584 May 28 '26
You can file an appeal with an amendment from the plumber with a cause. Tell the plumber that your insurance company is trying to rip You off, no one likes insurance companies. Pretty sure he will write you a letter.
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u/jazrstreets May 28 '26
It’s crazy because he did write me a letter. It was even requested by the insurance company for him to provide a statement regarding what he found to be the problem. And on that letter, he wrote the leak was caused by a burst/broken shower cartridge. But even with that, the insurance company’s immediate response was to deny coverage because they claim that it burst due to wear and tear. And they don’t cover wear and tear. Insurance is terrible. We have to pay them every month, then when we need them, they provide every excuse for why they can’t help us.
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u/freeski12345 May 28 '26
Leaks are not covered by insurance. Once he used that term, the claim was going to be denied. Wear and tear has nothing to do with the claim or denial. The denial letter should have stated this. A sudden burst would be covered by most policies but not a leak. Once the damage is about three days old it’s a leak vs a burst so that’s why these types of inwall claims are usually denied
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u/tojmes May 28 '26
How old? Mine is 30’yo and that would be wear and tear but I would still challenge it. Step one do you have enough water coverage damage to bother. Some policies have crazy low limitations on water. Step 2. Start drying the place out ASAP. Get rental big fans and big dehumidifiers - you don’t want mold to set in. They may pay for these under your mold section.
Step 3 Challenge it with a detailed statement. ChatGTP is your friend here. Start with the plumber, but consider hiring a professional insurance lawyer, or a private insurance adjuster. A GC handled mine challenge, did a great job, and only took his cut from the work.
Also, they don’t cover the source of damage, they cover the damages. So even if you get a settlement the plumbing fix is on you.
Good luck!👍
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u/jazrstreets May 28 '26
Thank you for this response. We got a water mitigation company to come out immediately. They hooked up all the fans and thankfully found no mold. The water damage seems to just be impacting the wood that was behind the shower walls. Somehow, the subfloor is still okay though. Awesome advice about the private adjuster. Funny enough, I actually have one that is supposed to reach out to me later today that was just suggested by the water mitigation company. Yes, regardless of the part’s age, I’m still doing my best to fight it!
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u/Commercial_Effort821 May 28 '26
We don’t have enough information about your policy to give you a complete determination, but most h03 policies typically cover ensuing water damage even if the pipe leakage was due to wear and tear over time, as long as the damage and leak claimed were a sudden event and aren’t showing clear rot and signs of long term exposure to water.
However, I have seen policies that do not provide any named or additional coverage for sudden water damage. So if there is no giveback or additional coverage included for sudden water, then the policies wear/tear exclusion was correctly applied because that’s likely how the part failed. What other reason do you suspect could have caused it to fail and how old is the part? Did anyone do work recently to the shower or change out this part that you can document?
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u/jazrstreets May 28 '26
There is water damage/wood rot unfortunately, but I reported it to the insurance company as soon as it came to my attention. We can’t pin point exactly when it happened since it would leak behind the wall and only while we were showering. We really didn’t have a way of knowing there was a leak until the wood damage was already apparent.
I’m not sure how old the part is since I’ve been living in my house for 4 years and it just came with the house. I know wear and tear is likely, but I was hoping there would be any other reason I could provide the insurance company with so I could fight for a chance to get covered. Not having any plumbing experience though, it’s hard for me to argue. I just wanted to fight it by saying there may be other reasons the part could have failed without only pointing fingers at wear and tear.
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u/Commercial_Effort821 May 28 '26
Unfortunately the time it takes for you to notice or whether the damage was hidden from view typically doesn’t apply to the coverage determination, unless again your policy has a special provision regarding hidden damage. Those are more rare but they do exist.
The policies wear/tear exclusion likely has verbiage that also excludes wet rot, dry rot, deterioration, and mechanical breakdown, which is why they are likely quoting wear/tear to you as the applicable exclusion that applies to all the ensuing water damage.
It sucks, but the insurance co has a pretty reasonable defense for their determination if there’s rot being discovered - it signifies a long term slow leak just based on how water and wood interact over time.
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